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Interestingly, the flow motion model shows that if a calcaneous cannot plantarflex the pelvis will struggle to tilt anteriorly.

This comes in a few scenarios:
Either
A) the pelvis is posterior tilted and cannot anterior tilt
B) the pelvis is already anterior tilted and cannot anterior tilt MORE
OR
C) the pelvis is neutral(ish) and struggles with movement at all in (at least) the Sagittal plane

Similarly the calcaneous could present so:
1) the calcaneous is dorsiflexed and cannot plantarflex – in a high arch cavus supinated foot type (for e.g)
2) the calcaneous is already plantarflexed and cannot plantarflex MORE (on the flat foot end of the spectrum)
OR
3) the calcaneous is neutral(ish) and struggles with movement at all in (at least) the Sagittal plane

The possible combinations are numerous. For instance A) could partner with any of the three outcomes 1), 2) and 3). Likewise for B and C.

I like option C)/3) where the structure is neutral(ish) but struggles to move. Without observation of its movement potential this structure would be unconsciously applauded as doing well according to it’s textbook neutrality and is often a piece of the puzzle that is overlooked. If it cannot move you are buggered. Regardless of how good it looks! 🙂

The key to any and all of these relationships of course is movement. If we are able to restore plantarflexion in any of the calcaneus based scenario’s, (1, 2 or 3) we’ll naturally begin to create the potential for anterior tilt at the pelvis and simultaneously minimise the compensations and adaptations taking place in the body to cover the ass of the non-plantarflexing calcaneous…

Of course the non-plantarflexion is probably not what hurts but the adaptations to this non-plantarflexion most likely do create an environment for discomfort or pain to show up. It might be that getting the calcaneous to move properly reduces the adaptations enough to reduce compromised movement elsewhere in the system.

It’s a shame there is another two dimensions of movement to consider and all those other joints isn’t it..?

The Flow Motion Model is designed to highlight all of these individual, coupled and dynamic relationships that take place in motion through this amazing body of ours.

Our next Finding Centre course is in New York State in Bridgehampton. Here you will find access to the course brochure and an email contact to to find out more information to inform you further about your expected experience on our courses.

If you would like to know more I urge you to get in touch with Chris – chris@anatomyinmotion.co.uk – and if you want to speak to me, ask him to push you my way. Failing that, if you would like a deeper insight into my work prior to making any decisions, please visit www.whatthefoot.co.uk (or Amazon.co.uk) to purchase a copy of my book. It will both serve as an insight and a support manual for when you will finally take the courses.

Anatomy in Motion is a way of reading movement patterns in the body as a way of understanding limitations, pain and problems in your patients and clients. Whether a chiropractor, osteopath, physio or rehabilitation specialist, you will find value in adding this simple (and fun) work to your bag of tricks.

It’s not just about therapy: movement is movement. Movement is exercise, training, coaching, pilates, yoga, running – whatever your game is in the realm of bodywork, correction, massage, rehab or re-education. Anatomy in Motion will add insane value to what you do. How do I know that? It’s one of those courses where you can bring your pain and problems with you, and leave without it. It’s starts with a journey into the human body, how muscles really work in movement, how joints stimulate a muscular reaction, how your mass and your brain (nervous system) should be given higher priority than the parts of your body that pull together to make your movement possible.

Motion is beautifully summed up by your gait and your gait beautifully informs us of patterns in the body that simply don’t add up and yet point a finger to the pain or problem with your patient, client or athlete. Imagine a world where you watch somebody walk and can join the dots to understand a problem, target it with movement, reintroduce new (or are they old?) patterns back in to the ailing human body and have the person walk out pain free…. not just for a day or two but for the long term. Imagine a world where your client, once corrected, stimulates and reinforces the correction with every step they take. Just the repetitive nature of walking along is their homework… This only comes with true integration from head to toe. Not just in the realm of joint patterns, but accompanied by high level functioning of muscular patterns, reinforced by a hardwired nervous system that simply adds value to better movement, less pain and a system organised in such a way that muscle tension and joint compression is limited, if not eliminated.

Our courses take you through the journey of understanding the three dimensional world of gait that is influencing every action you make, every step you take and it’s probable that it creates an environment for each injury you have or have had. Nothing influences gait like the reintroduction of three dimensional patterns and direct communication with the brain of what ‘works’ and what doesn’t.

We take you on a journey from the foot up and create an environment for your experience to build your learning. As a bodyworker of any discipline you will notice an incredible amount of correlation between your discipline and AiM as we seek to discover the nuance of the moving body that contribute to the clinical problems you are faced with daily… seemingly, all of which are governed by patterns and neurology, the very essence of what we investigate in the AiM Finding Centre course.

I’m grateful to David Weinstock of NKT who wrote the following in the foreword for my book: “What The Foot?…:

“When I was learning Anatomy in Motion with Gary, I realised what a powerful therapeutic modality it truly is. Experiencing the changes in my movement patterns and in my body when Gary artfully manipulated me with his very creative and innovative technique, made me fully appreciate the incredible system that he has created.

Why does a corrective movement system like AiM add value to other therapies?The beauty of Gary’s work is that it addresses movement dysfunction with the client in the position that is the basis for every activity – their gait. I have never seen anyone breakdown the gait in such incredible detail and relate it to the entire body as Gary has. Gary’s studies of the mechanics of the foot and ankle are impressive, but his creativity with movements to enhance changes to the entire musculoskeletal system is where his brilliance shines. Furthermore, his ability to teach all of this in a clear and concise fashion makes his classes immediately applicable and fun”.

We’re also showing up in the UK, Canada and Australia this year, hopefully Spain late on too. Keep your eyes on the Facebook page, my personal page or here for more information on all of that. Equally send us an email if that has caught your eye.

Remember the brochure for all of the AiM Finding Centre courses is attached at the top of this post – we look forward to hearing from you and more so, look forward to meeting you in 2015.

Remember to email chris@anatomyinmotion.co.uk to join us in May. If you are looking for a website, you may find an out of date website which gives you some idea of what we do. We’ve been working so hard on developing courses and material that the website has been delayed and delayed. If want to visit the old version, it’s here at www.anatomyinmotion.co.uk

Kinesiophobia – the fear of movement. Useful, beneficial and necessary in cases of acute pain where minimising movement to protect an injury is beneficial to the system. When that fear of movement extends beyond the duration of healing processes, however, we begin to have a problem. The problem arises as your body omits certain relative movements from its repertoire and begins to access others instead. This form of adaptation is known as compensation. If I can’t move my foot, I’ll move my hip more instead…

One case this week is of a guy who broke his neck in an RTA 30 years ago. He was placed in traction for two weeks, wore a halo brace for 6 weeks, a moulded neck collar for 3 months and a soft collar for a further 3 months. In essence he was not able to move his neck for 15 months due to external restrictions – when it’s highly possible that his break would have healed during some time in the first three months.

30 years later he is still wearing a metaphorical collar. It’s as if he never actually took it off. Neck range fully compromised in the frontal plane, 5 degrees of leftward rotation and 10 degrees of right rotation with accompanying poor sagittal plane spinal mechanics; neck flexion and extension compromised along with thoracic spine and pelvic tilts too. Naturally frontal plane spine motions and rotations have also been compromised. His whole upper body does not move. He leads with his eyes and hopefully his head and body follows.

When I held his head still in his upright stance and asked him to rotate his spine, however, I immediately saw that his spinal rotation improved and his relative neck rotation dramatically increased.

I said “It’s not that you CANNOT move your neck. It’s that you DO NOT move your neck”

When the neck does not move in this way it is possible to track backwards down to the feet and map the limitations and compensations in my Flow Motion Model to see the joints that are over working and under working. The only dominance in the neck was that of right rotation which occurs in left suspension and right shift phase making it very difficult for him to bear weight in his right leg.. Consequently he has a very heavy left leg limp. Using simple AiM movement protocol to get this guy back into his body, breathing correctly with good (better) spinal motion and accessing gait phases to get him back into his right leg again and critically giving the brain confidence to let go of the fear of moving his neck, we were able to take steps in the right direction.

By the end of the session he could turn his head 45 degrees to the left and 45 degrees to the right. With full flexion and extension and a much improved frontal plane. The pain he came to see me for – low back pain, dropped away once the brain understood that it no longer needs to operate for a stable, immobile, long forgotten neck.

The hardest part will be overriding 30years of pattern orientated behaviour of turning his whole body to talk to someone instead of just turning the neck… More work to be done

PS he has been having regular treatments to get his back cracked for the past fifteen years… When something doesn’t work repeatedly. It’s time to look elsewhere….

Interestingly, we are often able to track a person’s movement limitations back to a previous injury and are treating the adaptations potentially founded in their initial kinesiophobia.

This case of severs disease was a simple matter of two non-plantarflexing calcaneous bones. Why would they not plantarflex? Because of a non-symptomatic subluxation of C3, which had shifted forward, making it impossible for the patient to get a healthy extension of his thoracic spine or flexion of his cervical spine. Turns out falling off the see-saw age 3 wasn’t as innocuous as it first seemed….

The disease is not the discomfort in the heels. The disease is the prevalent pandemic of therapists and medics who choose to label symptoms rather than understand them, who choose to treat the pain rather than get underneath it…

It seems to me that there is a consistent theme showing up, one I have become very much aware of. The therapists, from all disciplines, who rise to the top of their game all seem to have a few things in common: primarily they think about the bigger picture, have experienced at some point in their working life that what they were taught or what the scientific papers suggest is not a whole truth when it comes to working with the human body and that there is more to working with the human body than meets the eye…. or hand….:

Curious

The therapist of the future is not satisfied with a simple outcome for their client. They know deep down that to rub a sore shoulder, treat a knee problem or offer an external ‘crutch’ may not actually be providing a solution for the patient. These are therapists who care about the end game. Not about managing the symptoms, or keeping them at bay but about understanding the essence of the problem. When it started? Where it came from? What you were doing at the time? What was happening in your life at that time? What happened before that that may have triggered it? They take histories and analyse them like a detective, somewhere they know somehow that a smack on the head age 3 has lead to your Achilles’ tendon problem that provides a persistent complaint today.

Pattern orientated

The therapist of the future is interested in patterns and is guided by rather than absorbed by the problem. They also choose to investigate patterns over taught procedures knowing that one will lead to a different solution than the other. Pattern observation always leads to a clearer understanding of how ‘stuff’ is redistributed through the closed chain system of the human body. Patterns give us insights to our movement behaviours, relationships between one muscle and another far removed from itself, gait patterns that quickly become habitual and repeated step after step, recognised by the bodybrain as necessary for survival. Muscle chains à la Myers, acupuncture and eastern meridians, simple (and complex) movement pattern work, determinations of gait, exploration of the nervous system and it’s intricate nature are all examples of ways to visualise and start to ‘see’ patterns prevalent in the human body and on show in your patients. The patterns you witness are the patterns that define the way your body has chosen to tackle it’s external environment given the structures in place. It’s motor control at it’s highest level. Your patterns put your problems on show. The modern therapist sees and feels them…

Detectives

The therapist of the future is not distracted by where the pain presents itself but recognises that both pain and trigger points could be holding the system together; their interest and fascination of patterns will lead them to an awareness of whether the pain is a problem, or if the pain is an outcome of a musculoskeletal adaptation elsewhere in the body. When a compromised body is being held together by soft tissue that becomes irritated, there is a need NOT to release the point of pain (via trigger point or foam roller for example) but to understand what that point of pain is working so hard for. Using patterns and looking at the whole picture, as well as understanding the system at large will lead to making appropriate changes that no longer require the body to hang on for dear life and allow the point of pain to dissipate as the system slowly reorganises toward a pain free and thriving state.

Let the body do the healing

The therapist of the future has an intuitive sense that healing takes place in the patient and not via the therapist. The body has all the conditions in place to heal itself (from anything) providing the over-riding parameters of the ‘condition’ no longer remain in place. Imagine a world where patients bought into this concept too, became less reliant on the therapist and more interested in how they managed to get into this situation. Imagine if they came into clinic and declared not that their knee hurts but that something in their system has changed and the outcome is the symptom they feel, and they asked you to investigate with a thorough history, an observation of their patterns (both physical and non-physical) and help them to understand the alarming downgrade in their system. Your response: “Of course, it would be my pleasure. Of course the first thing to be aware of is that the symptoms you feel are merely signals guiding us toward the original cause of your problem… So let’s be grateful for them hey?”

Swing both ways

The therapist of the future is not tied to the couch or a single modality, they use plinths as well as the gym floor, they explore manually as well as analyse movement and willingly observe open and closed chain mechanics in a bid to see which one carries more dominance; they piece the mechanical influences together through advanced understanding of whole body gait and interview the body to discover it’s motor control preferences and watch how the joint system and muscle system talk to each other to determine optimal patterns for every day use. No matter what their background and training they know that there is an emotional complexity to all of this that when understood can be invited to let go and witness the change ripple through the human body… This therapist definitely sits on both sides of the coin.

Wildcats

The therapist of the future is motivated by results and outcome and chooses to recognise that strange and powerful things happen when you leave the sphere of scientific understanding. They choose their own experience over what science suggests is ‘right’ and has even acknowledged that the scientific way often doesn’t lend itself to a useful outcome. The modern therapist (therapist of the future) is a wildcat, not born of strict rules and an education that points to a deep isolated understanding of the parts of the human body but is free to understand anatomy at the deepest level and yet observe it as a whole and integrated unit not separate from the issues of the mind so prevalent in our histories and the modern world we struggle about in.

The therapist of the future sits on a higher level, not of knowledge but of appreciation of the whole, is able to work on a plane that filters down to every tiny part of the anatomy. A thought can influence your physical properties and most probably does as the repetitive patterns of your mind run wild causing havoc in your body. A simple modification to a joint that sets a phase of movement up for success and is then directly experienced as an organised movement pattern is sufficient to ripple through the motor control centre and change the way you walk. The way you walk influences every segment of bone and every square millimetre of soft tissue. As muscles come to balance and walking patterns become optimal, the human body begins to thrive in a new space, taking on new breath, new thought, new blood flow, new neurological appreciation of itself and it’s talents. Can your body change your thoughts? Can your thoughts change your body? Perhaps only if the patterns – the influencers – that override the programming of all that are challenged to adapt to serve the system at large. That’s when patients no longer need to return week after week but have their own healing placed in their own hands. Patients of the future no longer rely on the therapist as a fixer and begin to take ownership of their bodies once again.

As our understanding of the human body races towards a new edge, as therapists from a variety of modalities come together, as personal trainers, no less, freely learn the skills to cause influential shifts in the structures of the human body. It should be clear for all to see that the therapy world as we know it is subject to change. No more labelling, no more abandonment onto schemes of pain management, no more surgical interventions without true cause of the problem bing uncovered first. Do I share a pipe dream or a vision of the future? I believe the latter as I am lucky enough to be one therapist, amongst many, who’s work and experience firmly has his sights set on making this a reality for the many.

The therapist of the future thinks clearly, thinks big, embraces patterns and complex challenges and takes every action possible to get underneath their clients signals to guide them towards a happier healthier future where there is always hope and always a solution.

People are in pain. Everywhere. They spend money freely on overcoming their problems without overcoming their problems. They are awarded labels for their condition even though it can be overcome with some open minded consideration of the whole. When a lady falls off her bike and bangs her hip which results in toe pain, has the toe fused (!) which did not work, has a single sesamoid removed (!), which also did not work, has the second sesamoid removed (!) and still doesn’t work before finally being told that there is nothing more to be done… Is this therapy? Or butchery? Will we one day in the future look back in horror at the barbaric approaches we carried out in the 20th and early 21st century? Surely it’s time to evolve as therapists and challenge the therapy industry around you to give hope and solutions to the people who need it most…

People in pain everywhere are desperate for you to do so… currently they struggle around looking for solutions and have seemingly lost all hope. This is not how it was meant to be…

Let’s take a look at the knee whilst considering the Second Big Rule of Motion (pp.56 What The Foot?) “Joint’s ACT: Muscle’s REACT” and take a look at the muscle system that is perfectly set up to react to the knee’s in motion movement.

The knee finds itself between the three dimensional ankle and the three dimensional hip. The knee is not technically a 3D joint – more 2D; or as I teach my level 1 students a one dimensional joint for ease of understanding.

That single dominant dimension is the Sagittal plane. The knee flexes and extends. Twice per stride, once in closed chain and once in open chain. Since the dominant motions lie above and below we have to assume optimal movement at both the hip and ankle in order to get what we want at the knee.

A closed chain knee flexion occurs when the foot is flat on the floor with the ankle dorsiflexing.

A standard knee flexion adds tension to the following muscles in the Sagittal plane at the knee:Primary

This of course is providing the standard accompaniment to a closed chain knee flexion are present above and below: ankle dorsiflexion and hip flexion/anterior pelvic tilt.

Tension in the muscle is where my interest lay. You may know it as lengthening or stretching, when in essence it is eccentrically loading (or locked in a long position in cases where the joint position is fixed). In any joint motion there will be excess shortening of some muscle tissue and excess lengthening in others. Excess is simply a way of observing more than is desired. Excess lengthening suggests the muscle accesses a state longer than it’s resting length while excess shortening suggests the muscle accesses a state shorter than it’s resting length. If you stand with a single flexed knee, you are probably aware of this.

The shortening muscles in knee flexion would be:Primary

Distal fibres of biceps femoris; semi-membranous and semi-tendinosus

Popliteus

Secondary

Proximal fibres of rectus femoris

Proximal fibres of gastrocnemius

The difference between a static posture (standing with knee bent) and a dynamic posture is obviously movement. Movement brings a whole new role and some might say complexity to muscles. Muscles that eccentrically load in movement are essentially being used to decelerate joint motion and minimise, yet allow, the body to venture away from balance, neutral or centre and stimulate a stretch reflex contraction in the lengthening muscle.

In motion, muscles lengthen to contract. The lengthening eccentric stimulus of knee flexion generates a subsequent contraction of the knee extensors and hopefully an accompanying eccentric load (lengthening) of the hip flexors and the simultaneous hip extensor activation.

Lots going on.

So in gait at the knee – in the sagittal plane – a simple knee flexion creates all that change in the tissues surrounding the knee. The reaction to a simple knee flexion is for the lengthening tissues to decelerate that motion, or control that motion to minimise over-flexion. The muscles which are lengthening at this point in time are the extensors of the knee – the muscles that will act to extend the knee. They contract concentrially in reaction to the knee flexion (the joint action):

Here we see the following muscles, those that were lengthening, now shortening to extend the knee from it’s flexed position:Primary

and those that were shortening now lengthening:(Lengthening to decelerate knee extension in gait)Primary

Distal fibres of biceps femoris; semi-membranous and semi-tendinosus

Popliteus

Secondary

Proximal fibres of rectus femoris

Proximal fibres of gastrocnemius

In Anatomy in Motion we see a lot of patients with individual muscle injuries or who are advised to foam roll or localise treatment on individual and specific muscles. Firstly look again at the lists above. It highlights that in the sagittal plane, in a closed chain environment that no biaxial muscles are fully lengthening or fully shortening, but in fact tension is redistributed from the distal portions to the proximal portions of an individual movement to manage the motion of the surrounding joints.

A simple way of reorganising the muscle tensions in all muscles is simply to teach the knee (not forgetting the joints above and below) to simply flex correctly. For the the three structures, foot, knee and hip, to move in such a way that the tension is not excess in any tissues at any point in time during the walking process.

Just to promote knee flexion, with ankle dorsiflexion and hip flexion in a sagittal plane environment will bring all of the above mentioned muscles into line. This is why we follow the Second Big Rule of Motion “Joints ACT: Muscles REACT”.

Concentric stimulus

I’ve said many times that in motion there should be no primary concentric stimulus. Concentric actions are “effortful” and – when in motion – present as a result of failed eccentric load or joint positioning.

Look back at the muscles that are loaded (lengthened) in knee flexion. Muscles which attach directly onto the front of the knee load in flexion, their concentric partners will be shortening but should not be over working to do so.

A concentric muscle action has a simple goal. To kick start the muscle journey back towards centre from it’s lengthened position. The actual concentric contraction seems to last for a moment with the eccentric contraction lasting way longer as the momentum of the mass requires urgent deceleration and control. Once the concentric contraction fulfills it’s goal of bringing the joint back towards it’s midline, momentum takes over and the body lurches forwards – awaiting muscle’s on the oppsoite side to pick up the deceleration role again. The more time we spend in a concentric action, the more effort there is in our movement and the less energy we have to spend on our eccentric activity which allows us our freedom of movement.

Frontal and transverse plane at the knee

In a good healthy knee, there should be no frontal plane motion available. Observers of the frontal plane may beg to differ but once again it is the hip and ankle in the transverse plane that give the appearance of a knee that passes inside the midline. An internal rotation of an ankle coupled with a sagittal plane flexion of the knee will give any frontal plane observer a sense of a knee that has crossed the midline of the body in the frontal plane. AND it does; so it pays us to understand the muscles that are set up around the knee to help control this movement inwards to a position where it appears to have no support beneathe it.

As the leg rotates internally and is flexed towards the midline, it’s worth taking a look at the muscle’s and structures which are set up to manage it. Tension is added to the following muscles in the frontal / rotatonal planes at the knee during the closed chain gait cycle when the foot is flat on the floor:

The knee is truly compromised as it journeys inwards. When it stands in centre, it has the luxury of a strong pillar beneathe it (the tibia) upon which to stabilise, as it ventures towards the midline it has less and less of that luxury and must begin to rely on the muscle and ligment system strapped to it. It seems, to me anyway, that one look at these muscles and you can see that pretty much all of them must act to control any dangerous venture of the knee away from it’s midline, even the ITB and lateral quad and hamstring muscles – I know people don’t think the ITB does much, but I have to say, that in movement a) you can feel it and b) those with problems in the ITB always have issues with speed of ankle pronation and knee passing toward the midline! So again, less cadaver based science and more ‘feeling while doing’ please! Even the lateral tissues appear to have to control an inward motion of the knee. It’s that much of a responsibility.

Before anyone points out that I’m the first to say that the “Knee over Toe” discussion is moot. I’d like to agree and stress that this is another movement that we must explore and yet not access in excess. To get the knee to comfortably pass inside, the tissues mentioned above MUST be in a position to allow this movement whilst preventing an excess of it. Again, the motion of this joint in these planes means that the reactive concentric action will be one that extends the hip and knee from their flexed positions (as seen above) whilst also abducting the hip from it’s adducted position, externally rotating the hip from an internally rotated position, and also resupinating the foot from it’s pronated position – which drove the knee inwards in the first place!

It seems there are a whole bunch of muscles set up to control these wayward movements of the body and yet the wayward movements of the body are designed to wind up the muscles for an optimal contraction. This is the deep irony as to why we focus fully on stability in a fully three dimensional and mobile structure.

Once again, working with the structures of the foot, knee and hip to promote good clean healthy movement accessing all available ranges in all three dimensions in the skeleton is your single solitary ticket to bringing all responsible muscles into line. Trust me: They WILL always react to the quality of joint motion in the joint in question. Saves chasing after the one and means you can target the many muscles involved and dynamically stabilising your system – not omitting the quality of muscles in far flung outreaches elsewhere in the body 🙂